Li Hong, Chen Yuzhou, Chen Shiyi
Department of Sports Medicine, Huashan Hospital, Shanghai, 12 Wulumuqi Zhong Road, Shanghai 200040, People's Republic of China.
J Orthop Translat. 2019 Jan 28;17:96-102. doi: 10.1016/j.jot.2019.01.001. eCollection 2019 Apr.
The purpose of this study was to investigate the effect of hyaluronic acid (HA) in the tendon-bone healing process after rotator cuff repair in a rabbit model.
In vitro, rat bone marrow stromal cells (rBMSCs) were cultured in media for cartilage-related and inflammation-related gene expression levels examination at 1.0 mg/mL of HA. In vivo, 48 New Zealand white rabbits underwent rotator cuff repair surgery, and they were randomly divided into three groups: (1) control group (n = 16), (2) microfracture (MF) group accepting MF treatment (n = 16) and (3) MF/HA group accepting MF with HA treatment (n = 16). Four rabbits from each group were sacrificed at 6 and 12 weeks postoperatively for histological evaluation and biomechanical testing.
In vitro experiments reveal that HA significantly decreased inflammation-related mRNA expression (IL-1, TNFα) compared with the control group. At 6 weeks after surgery, there was no significant difference of load-to-failure between groups. At 12 weeks after surgery, the mean failure load of the MF/HA group was significantly higher than that of the control group (100.5 ± 10.1 N vs. 68.0 ± 6.2 N; = 0.0115). The mean failure load of the MF group appeared higher than that of the control group, whereas there was no significant difference ( > 0.05). Histologically, more chondrocytes were clustered at the tendon-bone interface, and more extracellular matrixes were produced in the MF/HA group. The interface of the MF/HA group appeared similar with the normal tendon-bone interface.
HA may play a crucial role in the acceleration of tendon-to-bone healing which might be through inhibiting inflammation. Rotator cuff repair using MF along with HA led to better tendon-bone healing and a subsequent increase of biomechanical strength at the repair site.
HA injection is very common for patients with rotator cuff disease because of its antiinflammatory action and adhesion prevention preoperatively. The HA injection during surgery provides an antiinflammatory effect during tendon-bone healing process and leads to better tendon-bone healing postoperatively.
本研究旨在探讨透明质酸（HA）在兔模型肩袖修复术后肌腱-骨愈合过程中的作用。
体外实验中，将大鼠骨髓间充质细胞（rBMSCs）培养于含1.0 mg/mL HA的培养基中，检测软骨相关基因和炎症相关基因的表达水平。体内实验中，48只新西兰白兔接受肩袖修复手术，并随机分为三组：（1）对照组（n = 16）；（2）微骨折（MF）组，接受微骨折治疗（n = 16）；（3）MF/HA组，接受微骨折联合HA治疗（n = 16）。每组分别于术后6周和12周处死4只兔子，进行组织学评估和生物力学测试。
体外实验显示，与对照组相比，HA显著降低了炎症相关mRNA的表达（IL-1、TNFα）。术后6周，各组间的失效负荷无显著差异。术后12周，MF/HA组的平均失效负荷显著高于对照组（100.5±10.1 N对68.0±6.2 N；P = 0.0115）。MF组的平均失效负荷高于对照组，但无显著差异（P>0.05）。组织学检查显示，MF/HA组肌腱-骨界面聚集了更多的软骨细胞，产生了更多的细胞外基质。MF/HA组的界面与正常肌腱-骨界面相似。
HA可能通过抑制炎症在加速肌腱-骨愈合中起关键作用。采用微骨折联合HA进行肩袖修复可促进肌腱-骨愈合，并提高修复部位的生物力学强度。
由于HA具有抗炎作用且术前可预防粘连，因此HA注射在肩袖疾病患者中非常常见。手术中注射HA可在肌腱-骨愈合过程中提供抗炎作用，并导致术后更好的肌腱-骨愈合。
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